Treatment Action Campaign at the Precipice: An Opportune Time for Reflection

A recent petition by researchers, clinicians and activists made on behalf of the Treatment Action Campaign and published in the Mail & Guardian Newspaper, 28 November, 4 December 2014 Edition, The Case for Saving the TAC is Compelling, left me with mixed views on the TAC’s plight as petitioned. The TAC is evidently not unique in its current funding crisis in South Africa. Many vibrant organisations have, more recently, closed their doors, and many more are going through rugged terrains to remain relevant and afloat while meeting much needed social and health needs.

While the petition is commendable and substantial, given the respectable calibre of its signatories, as a reader, I was left with many questions. What happened to what had become (and still is) a beautiful and reflective recent case study of civil society action in South Africa? From a business case’s point of view, how did the TAC lose its competitive advantage? What influenced the change in business confidence among social investors (funders) thereby leaving it on a financial decline to the extent of facing closure? Sometimes, it is easier to blame external forces. Even much easier, as I have grown to know, to point fingers at donors for withdrawing funding.

It is important to note that the petition is silent in attributing the TAC’s own shortcomings to adapt to the times after its successes. In playing the devil’s advocate, with hope that it will help all of us with interest in social change through civil society structures, I am of the view that the two reasons given in the petition i.e. withdrawal of funding because South Africa is viewed as a middle income country and the belief that AIDS is nearing the end are not good reasons for its looming demise.

Social movements, by their very character, are based on a particular pertinent social justice issue at a particular time in society. Their existence and longevity in context, are key characteristics that define their relevance. Historically, social movements have played a significant role in ending apartheid. The transition to democratic rule witnessed the demise of many social justice movements that were on the cutting edge in fighting apartheid. In many instances, these movements were generously funded by the local and international donor communities who believed in the cause.

Progressively so, many donors changed their funding focus to reconstruction and development post 1994. It was left to social movements to transform and align themselves with the collective agenda of the day. Others successfully changed their mission statements, while others could not comprehend the reasoning to transform and align or merely found themselves incapacitated to adapt. As a result, many failed to embrace change as a constant and closed down voluntary and others involuntarily.

In my view, nobody or any institution that I know of, I stand corrected, has been complacent, or sought to dismantle and demobilise civil society in South Africa as suggested in the petition. Instead, many donors continue to demonstrate commitment in aiding all progressive and relevant development actors in their work. I believe, it is all about the TAC’s business case and what it is they are offering social investors who have interest in furthering the objectives of an effective and sustainable health system. When such is appealing, like in any case, there is no investor who would think otherwise.

At the same, be that as it may that South Africa is a middle income country, comparative studies will indicate that the social investment environment is more conducive elsewhere on the continent in which countries are much poorer. Therefore, business logic also would suggest a drive towards such. Gross unspent budgeted funds year on year, perceptions of corruption and blatant opulence in the midst of unacceptable levels of poverty, blend poorly in seeking donor funding in South Africa.

As a lay man, deeply concerned and seeking to be of assistance, albeit, not in financial terms, I humbly submit a few points for us to consider in TAC’s case:

  • The TAC can review its mission in relation to its relevance in the current public health development trajectory. Is it better to respond to the challenges noted in the system from a protestant perspective or as an institution that can support rather than oppose current efforts by government and other structures including donors already committed  to doing so;
  • Linked to the above, reconsider an alternative move from a membership organisation with 182 branches to a much more centralised and specialised institution with a niche service and product offering. The 8 000 members and 182 branches across the country that the TAC has might not be the best way to put up a case for sustaining the organisation. More so, to what extent are the current members experiencing value from TAC’s services as would be expected from a membership organisation? Answers to such will assist in decision making if the R10 million needed is nor received by February 2014;
  • There are a number of bi-lateral agreements between government and donors that are aimed at strengthening the capacity of South Africa’s health and social systems for service delivery. These agreements have also considered the global decline in funding. As a result, many have found it necessary to fund the strengthening of government systems and its human resources skills base for sustainability purposes. You will agree with me that civil society organisations come and go and yet government systems and its institutions will exist longer. This commitment includes support of locally based development actors to be able to work hand in hand with government. It may therefore not entirely true that all donors are moving away because SA is thought to be a middle income country. It is the funding focus areas that are changing which have also become highly technical and specialised hence funding being readily available for such than protest action;
  • The assertions that the gains achieved so far in the fight against HIV and AIDS could go into reverse if the TAC is allowed to die ‘for lack of funding will have grave consequences’ is a bit exaggerated. I do not by any chance suggest that the TAC’s contribution has been insignificant, actually it has been a key landmark in public health as far as HIV and AIDS is concerned. The point is that, there are many other actors, even smaller in size and public posture, than the TAC, which are helping to sustain the gains achieved to date. I do not think it is in the mind of government to wash down the drain the gains achieved to date. Instead, I guess, there is a greater call for civil society to be of help in moving towards the zero targets. Therefore, the question to TAC is, how does it become a strategic partner to current collective efforts that are supported by donors? More so, acknowledge the fact that the TAC is not entirely synonymous with the gains achieved to date neither the sustenance of such into the future;
  • South Africa has a rich culture of protest action. While we have well recorded successes of such action, it is important to also reflect on the effectiveness of such action beyond marches and placards in the TAC case. We have tended, through protest, to talk past each other and consequently not achieving the common good. To achieve what you desire, sometimes it means partnering with the most unlikely of partners even if its government in its perceived incompetence. So if the desired is achieved as a result, who cares? The TAC may need to let go of its former glory and consider new avenues waiting to be explored in strengthening South Africa’s response to HIV and AIDS;
  • Sustainability is not always about funding and having financial reserves, it is also about the relevance of a service or product offering in the market place. If such is still needed, funding will come easily. If not, scan and define a new market or gap. One cannot help but observe the shared leadership between the TAC and Section 27. Could it be that the later usurped the next phase or prophetic call of the former?

There might be, as is usually the case, a silver lining in all this. Perhaps an opportunity to reflect and learn from past experiences for the benefit of all. One lesson for all to think about is the fact that we cannot continue to sub-contract our own development as Africans. At some point, we must take responsibility and devise our own sustainable and innovative means to fund, strengthen and improve the effectiveness of our social and health service delivery systems.

As a treatment campaign, the TAC did well. Modern history in public health attests to such. Civil society campaigns, have always come to an end once the goal has been achieved. I can perhaps ascribe the same to the TAC. I do not think the TAC will be judged harshly if at all it closes its doors. As a social movement or rather a campaign, it need not be compelled to continue to exist even when circumstances do not allow. It perhaps needs to seize this opportunity to reform, rebrand and transition from a campaigning approach to an institution, adapting and adopting the key priorities in the public health sectors. At its disposal is a deep, solid and profound foundation upon which to resurrect itself, that is, its successes in the echelons of access to treatment for people living with HIV and AIDS in South Africa.

Today SA stands with about 2.7 million people on treatment, the largest ARV roll out programme in the world. This cannot be mentioned on podiums without boldly stating the TAC’s contribution if the truth can be told. The TAC can take pride in that.

In his personal capacity, Thami Sonile offers regular commentary on nonprofits and social development issues and loves a robust and constructive debate. He can be contacted via email thamisonile@gmail.com.  

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